I have a hole under both breasts. Both are leaking yellow thick puss. Could my implants be exposed? necrosis? (photos)

A lift with an implant is controversial for two reasons.  First, when you perform a lift you are making everything tight and closing the wounds under tension.  It you add the expansive forces of the implant at the same time, you are fighting against yourself.  There are forces on the wound which try to make them separate, which results in wider, thicker, more irregular scars.  In the worst case, the wounds will open.  So compromises are usually made in the operating room by the surgeon because they cannot close the lift wounds over the appropriate sized implant.  Either less of a lift is performed so that the skin is not as tight and therefore there is less tension on the closure.  Or a smaller implant than would be appropriate is used so as to decrease the expansive forces.  Either way, you are compromising the aesthetic outcome.  Often the outcome is so compromised that a second revision surgery is required.  If however, you plan to have the lift first and then the augmentation after everything has healed, then you have two operation that are planned, both with much lower risk than the combined mastopexy/augmenation.  The outcomes of the two meticulously planned operations are much better and a more aesthetically pleasing, and a safer outcome is achieved.





The second reason the combination of mastopexy and augmentation is controversial is because of the risk of nipple necrosis (death of the nipple).  By making the skin tight for the lift, you are putting external pressure on the veins that supply the nipple.  By putting an expansive force on the undersurface of the breast with an implant, you are putting pressure on the thin walled veins that supply the nipple.  If the pressure by squeezing the veins between the implant and the skin is greater than the venous pressure in the veins, the flow will stop.  If the venous outflow stops, the arterial inflow is stopped.  If the arterial inflow is stopped, there is no oxygen for the healing wounds and the tissue dies.





Placing the implant on top of the muscle in combination with a lift puts the blood supply to the nipple at a much higher risk because in addition to the issue of pressure on the veins, you have to divide the blood vessels that are traveling from the pectoralis muscle directly into the breast (and to the nipple) in order to place the implant between the breast tissue and the muscle. This adds a third element of risk to an already risky operation.  Mastopexy/augmenation with sub glandular implant placement is by far the riskiest way to address your anatomic question.

Hello,I'm sorry to hear about your difficulty. Your best course of action is to follow up in person with your Plastic Surgeon- ASAP and then continue with regular, in person assessment. Follow their instructions for wound care.All the best

It is very difficult to determine whether the implants are exposed.  The silvadine always makes a goopy bad looking mess as its working.  Check with your plastic surgeon.

difficult to say without exam.  I always warn people that silvadene looks like pus after 12 hours. in my hands the implant would be under muscle or fascia so I would not be worried. but stay in  constant contact with your surgeon and make regular visits

Thank you for your question. I recommend that you make an appointment with your plastic surgeon as soon as possible. They will be able to guide you through your convalescence and give you detailed instructions on wound care.

Thank you for your question. Opening at the "T" junction after mastopexy is not uncommon. Drainage can be expected . Only your surgeon will be aware of how  at risk your implants are for being involved since coverage over the bottom of your implants is technique dependent. If you are comfortable and confident in your surgeons abilities stick with your current care. If you  are not comfortable with your level of care seek out the opinion of a qualified surgeon in your area for a second opinion. Best of luck!

Thank you for your question. You need to see your PS for evaluation. In pictures we can not tell about your implant exposure. You need a physical exam . 

Thank you for your question.  I'm sorry this is happening to you.This needs to be followed very closely by your plastic surgeon.  The implants aren't visible in the pictures, but a physical exam may reveal they are exposed.  It's unclear if that's pus, or if that's the SSD after it's been in the wound for a while.  Again, make sure your plastic surgeon is following you very closely.Cheers,Dr. Dan KrochmalMAE Plastic SurgeryNorthbrook, IL

Yes your implants could be and are likely exposed and infected. You need to see your surgeon immediately like today to get that cleaned up and fixed.

Thank you for the photos. It appears from them that you have had a mastectomy (breast lift) in the past. It is fairly common to develop problems at the point where the vertical and horizontal incisions from a breast lift meet. When implants are inserted, all of the weight is put on this very spot. For this very reason, I have developed my own protocols for placing implants post-lift. There is a risk of the implants being exposed so I would highly recommend continued follow up with your surgeon so that the open wounds can be healed. Discuss with him/her your concerns, look into other options if this treatment does not appear to be improving things, and follow instructions carefully. SSD treatment can be messy and be confused with pus, but you don't want to take chances with infection or implant exposure so contact your surgeon.